DonDon’’t Forget CHIPRA!t Forget CHIPRA!

Performance Performance BonusesBonuses

& More& More

National Covering Kids & Families NetworkWebinar – February 8, 2011

Tricia Brooks

Lots of Good Stuff in CHIPRA: Lots of Good Stuff in CHIPRA: Financing, Coverage, Benefits and QualityFinancing, Coverage, Benefits and Quality

o Higher funding levels with many safety valves

o Explicit authority to cover up to 300% FPL

o New CHIP dental benefit requirements, option for stand-alone dental plan

o New quality provisions, demonstration projects and reporting requirements

Electronic Match with SSAElectronic Match with SSAto Verify Citizenshipto Verify Citizenship

o Most popular CHIPRA provisiono Builds on existing data

exchange between states and Social Security Administration

o Adopted by 29 states in 2010o 15 more plan 2011

implementationo Extremely cost-effective and

accurate

AZ AR

MS

LA

WA

MN

ND

WY

ID

UTCO

OR

NV*

CA*

MT*

WI MI

NE

SD

ME

MOKS

OHIN

NY

IL

KY

TNNC

NH

MA

VT

PA

VAWV

CTNJ

DE

MD

RI

HI

DC

AK

SCNM

OK

GA

TX

FL

AL

Medicaid onlyMedicaid and CHIP or Medicaid Expansion

SOURCE: Based on a national survey conducted by Georgetown Center for Children and Families and the Kaiser Commission on Medicaid and the Uninsured.*Note - CA plans to implement in CHIP; NV and MT plan to implement in Medicaid in 2011

IA

Plan to Implement in 2011CHIP only

States Adopting SSA Match States Adopting SSA Match to Verify Citizenshipto Verify Citizenship

January 1, 2011January 1, 2011

Lifting the 5-Year Bar for Lawfully-Lifting the 5-Year Bar for Lawfully-Residing Children & Pregnant Women Residing Children & Pregnant Women

o Also popular CHIPRA provision

o Previously, federal funds available only for immigrants in county more than 5 years

o Federal help for states using state only funds, but at least seven states expanded coverage

Source: Based on the findings of a national survey conducted by the Georgetown Center for Children and Families and the Kaiser Commission on Medicaid and the Uninsured, 2011. Note: includes states that have adopted ICHIA in Medicaid, CHIP, or both programs.

FL

NC

SC

GALATX

AL

AR

KS

OKAZ TN

MS

NVUT

NM

CA

WYID

WA

ORND

SD

NE

MT

MO

IN

MI

WI

IL

ME

OH

KY

HI

AK

PA

WV VA

CTNJ

DEMD

RI

NHVT

DC

MA

CO

IA

NYMN

Children Only Waiting for CMS to Approve SPA: PA, IL (both); TX (children only)

Both Children & Pregnant Women

States Adopting Coverage for Lawfully-States Adopting Coverage for Lawfully-Residing Children and Pregnant WomenResiding Children and Pregnant Women

January 1, 2011January 1, 2011

Pregnant Women Only

Outreach Tools to Outreach Tools to Enroll Eligible ChildrenEnroll Eligible Children

o $100 million more for outreacho Outreach proposals due April 18,

2011 for next round of $40 milliono National outreach summit

o Enhanced match (75%) for translation & interpretation

o Connecting Kids to Coverage Challenge

o Get in the Game Campaign

o Insure Kids Now Website

The Performance BonusThe Performance Bonus

o To reward states for (and help offset the cost of) enrolling low-income children in Medicaid

o Two requirements:o Meet certain enrollment

targets in Medicaid

o Implement at least 5 of 8 measures to increase enrollment and retention

Performance Bonus CalculationPerformance Bonus Calculation

o Enrollment targets…o Cumulative annual increases over average monthly

enrollment FFY 07, adjusted by % change in child population

o +4% in FFY 08, 09o +3.5% in FFY 10, 11, 12o + 3% in FFY 13 (ACA ends bonuses in FFY 2013)

o Two bonus levels…o Tier 1 = number of children enrolled above target X

15% of state share of Medicaid costo Tier 2 = Number of children enrolled above 110% of the

target X 62.5% of state share of Medicaid cost

Eight Measures to Improve Eight Measures to Improve Enrollment and RetentionEnrollment and Retention

FFY 09 Bonus AwardsFFY 09 Bonus Awards

FFY 11 Performance BonusFFY 11 Performance Bonus

o If legislation is required for a measure, it would have to be enacted by October 1, 2010.

o Measure would need to be operational at least 6 months (April 1, 2011) and

remain in effect on September 30, 2011.

o Measures must be in place for both Medicaid and CHIP, except premium assistance.

Too Close to Turn Back NowToo Close to Turn Back Now

o Children’s coverage has reached a record high >90%.

o Nearly two-thirds of uninsured children are currently eligible for Medicaid or CHIP.

o Streamlining enrollment andrenewal can help reach these children AND achieve administrative cost savings.

o Outreach continues to matter.

Contact InformationContact Information

Tricia BrooksSenior Fellow

Georgetown University Center for Children and Families

pab62@georgetown.edu

http://ccf.georgetown.edu/

http://www.theccfblog.org/

202-365-9148